QUIZ- postop Flashcards
PACU=
post anesthetic care unit
PAR=
post anesthesia recovery. same as pacu
POD0
post op day 0, day of surgery
PONV
post op nausea vomiting
GA
general anesthesia
d/c
discharge or discontinued
lap
laparoscopic
open
incision
nurses role in the recovery room?
- more freq assessments in initial post op period (ex q15 min in pacu)
- airway management, preventing hypoxemia, hypercapnia
- cardiovascular stabilization
- managing acute pain
- controlling PONV
- relieving anxiety
- preping for transfer to surgical unit
nurses role in surgical unit?
help pt recover from anesthesia
- assess vitals
- monitor resp, cardio, neurologic status
- monitor for complications,
- pain management
- promoting self care
- prep for discharge
how do we know what to expect as a “normal finding””?
-pts baseline!!! what is expected
post op complications: resp
atelectasis, pneumonia, PE aspiration
cardio post op complications
shock, thrombophlebitis
neurologic post op complications
delirium, shock
skin/wound post op complications
breakdown, infection, dehiscience, evisceration, delayed healing, hemorrhag, hematoma
GI post op complications?
constipation, parlytic ileus, bowel obstruction
urinary post op complications?
acute urine retention, urinary tract infection
functional post op complication?
weakness, fatigue, functional decline
thromboembolic complication?
DVT, PE
priority problems/nursing diagnosis
N&V ineffective airway clearance pruritus urinary retention risk for activity intolerance
enhanced recovery after surgery…
- multimodal, multidisciplinary perioperative pathways
- designed to shorten recovery and decrease complications
- principles incorporated into clinical pathways and order sets
- preop: education, smoking and alcohol cessation, nutritional optimization
intraop: short acting anesthetics, minimize IV fluids, PONV prophylaxis
postop: early mobilization, advance diet quickly, supplemental nutrition, change to oral analgesic - patient involved and patient centered
Post op orders and pathways?
are specific to surgery or general
- clear goals and direction
- highlights interventions
- interdisciplinary team document on same pathway
- if someone has “fallen off” the pathway—> not meeting expected outcomes
post-op pain control principles?
pain is what the patient says it is
may be opioid sensitive or tolerant
-consistent admin better than PRN
-assess before/after interventions and document
-anxiety and fear increase pain experience
-use pain control adjuncts
-monitor for side effects
what is patient controlled analgesia?
effective way to control pain
- increases patient feeling of control
- pt must be cognitively and physically able to use it
- can be through IV or epidural
- only pt can push button!!
- there is a “lock out” period between doses
- teaching essential
IV PCA assessments?
vitals, pain, sedation scale, resp function, NV, pruritus, insertion site, bladder function, bowel function
patient controlled epidural analgesia?
- same assessments as with IV PCA PLUS
- –> motor function (bromage scale)
- —>sensory deficit assessment (ice test)
with post-op ambulation watch for
orthostatic hypotension
—> requires pain management without over sedation
postop nutrition and hydration?
- need adequate nutrition
- protein, vit A and C, zinc
- IV solution
- Fluid balance and requirements
pediatric considerations?
- involve child as much as possible
- provide distraction
- allow them to express their feelings
- provide positive enforcement
- incorporate play
mini med card for ranitidine?
gastric acid reduce (histamine h2 antagonist)
-given PREOP to pt at risk of aspiration (like sodium citrate)
inhibits gastric acid secretion and gastric volume
slower onset than sodium citrate
-monitor for CNS changes, can cause confusion
IV general anesthetics: propofol and midazolam
both IV general anesthetics
advantage of P: rapid onset, rarely malignant hyperthermia
advantage of M: no pain on injection, can produce amnesia, short acting
mini med card on propofol…
IV general anesthetic
- induction and maintanence of GA, sedation
- rapid onset, rarely any malignant hyperthermia
- can be painful when injected, decreases CO and resp drive
- monitor for HTN and resp depression, elimination half life is short (34-64 mins)
mini med card on midazolam…
iv general anesthetic, benzodiazepine
- to induce anesthesia often w other meds, preop sedation, decrease anxiety
- no pain on injection, can produce amnesia
- slower induction
- monitor VS and level of sedation
- can cause resp depression, N/V
nursing management after surgery (first 24 hours)
recover from effects of anesthesia, physiologic status, monitoring for complications, managing pain, implementing measures to achieve long-range goals of independence, discharge to home, and full recovery
primary concerns in initial hours after admission to clinical unit?
adequate ventilation, hemodynamic stability, incisional pain, surgical site integrity, n&v, neurologic status, spontaneous voiding
pulse, BP, RR recorded…?
15 mins for first hours, 30 mins for next 2 hours, and then less freq if remaining stable
focus shifts from intense physiologic management and symptomatic relief of adverse effects of anesthesia to…
regulating independence and prep for discharge
things to expect in post op that show they are progressing?
begin breathing and leg exercises as appropriate, dangling legs over edge of bed, ambulating a bit, tolerating light meal, IV fluid discontinued
shallow and rapid respirations may be caused by
pain, constricting dressings, gastric dilation, abdominal distension or obesity
flash pulmonary edema?
possible complication—> occurs when protein and fluid accum in alveoli
-signs and symptoms= agitation, tachycardia, decrease pulse oximtery, pink sputum
major goals of post op
resp function optimal and CV function, relief of pain, increased activity tolerance, unimpaired wound healing, maintenance of body temp, maintenance of nutritional balance
resp complications?
atelectasis: risk for pt not moving or doing deep breathing: decreased breath sounds, crackles, cough
pneumonia: chills and fever, tachycardia
hypostatic pulm congestion may develop
hyoxemia: subacute vs episodic
subacute: constant low level O2 when breathing appears normal
episodic: suddenly, pt at risk for cerebral dysfunction, MI, cardiac arrest
2 requirements to use a PCA:
-understanding of need to self-dose
and
-physical ability to self-dose
pros of a PCA?
promotes pt participation in care, eliminates delayed administration of analgesics, maintains a therapeutic drug level, enables pt to move turn cough and take deep breaths
what is intrapleural anesthesia
- provides sensory anasthesia without affecting motor function to intercostal muscles
- allows more effective coughing and deep breathing
who is coughing contraindicated in
head injuries or intracranial surgery or eye surgery or plastic surgery
if pt has catheter report…
less than 40 ml /hr
if pt voiding report..
output of less than 240ml per 8 hr
promoting cardiac output…
monitor ins and outs, hydration, mobility, monitor labs (hematocrit, hemoglobin) kook for altered tissue perfusion
benefits of encouraging activity
-effects recovery and prevents complications:
reduces postop abdominal distension
prevents stasis of blood
pain often decreased, hospital stay shorter, less costly
maintaining normal body temp…
at risk of malignant hyperthermia and hypothermia
- identify it and treat early
- comfy temp, blankets, O2, hydration, nutrition
when is nasogastric tube inserted
preop if vomiting risk is high d/t surgery
also may be inserted before surgery if postop distension is anticipated
hiccups and surgery
may be produced by intermittent spasms of diaphragm secondary to irritation of phrenic nerve may be indirect or indirect, if persist physician may prescribe nothiazine meds
abdominal distension after surgery may be due to
accumulation of gas, further increased by immobility, anesthetics, and opioid meds
-can be avoided by getting pt to turn, exercise, ambulate early
potential GI complication?
paralytic ileus and intestinal obstruction
when is pt expected to void after surgery?
within 8 hrs after surgery—> methods encouraged to help pt void before catheterization (like letting water run, applying heat)
bed position immediately after post up?
low, side railings up
prophylactic treatment for DVT
heparin, warfarin
also can use pneumatic compression and antiembolism stockings
first symptom of DVT?
pain or cramp in calf, initial pain and tender following swelling of entire leg
hematoma management
physician will remove some suture and clot can be evacuated and wound is packed tighly
wound infection may not be evident until
at least post op day 5! most pts are discharged at this time
dehiscence of wound=
disruption of surgical incision or wound
evisceration=
protrusion of wound contents
earliest sign of wound infection may be:
gush of serosanguineous peritoneal fluid from wound
what do you do if there is disruption to the wound?
place pt in low fowler position and instruct to lie quietly, cover protrusion coils of intestine w sterile dressings
peds- continuous monitoring of _______ status is essential during immediate postop
cardiopulmonary status
in susceptible children what triggers malignant hyperthermia?
inhaled anesthetics and muscle relaxant succinylcholine trigger the disorder, produce hypermetabolism
symptoms of MH
hypercarbia, elevated temp, tachycardia, tachypnea, acidosis, muscle rigidity
treatment of MH
immediate discontinuation of trigger, hyperventilation w oxygen, IV dantrolene sodium, cooling measures, transfer to CCU
child needs to change position
every 2 hours
most commonly used IV PCA opioid?
morphine
patient safety to PCA?
numerous benefits, but processes around PCA can threaten safety
-errors include each phase of medication-use process (from prescribing, through transcribing, dispensing, administering, monitoring
typical PCA order includes:
patient, allergy info, analgesic product to be used, initial loading (bolus) dose, basal rate, lock-out interval, duration
nurses role in administering and monitoring PCA
- review prescribers order, set the parameters (loading dose, lock-out interval, basal rate)
- provide education
- assess cognition of pt (ensure they can use it)
- secure programmable device and specialized tubing
nursing should be well versed in assessing patients whaaat for PCAs?
resp status!!! opioids
-common to use resp monitoring equipment when PCA is in use to increase safety
treating an overdose of a PCA should be aimed at
establishing patent airway, and if necessary ventilatory support
PCA by proxy? what is this
unauthorized person presses delivery button to deliver med to pt
- increases risk of harm
- nurses must educate pt and visitors, family, friends that the dangers of proxy !!
